Role of one, two and three doses of high-dose chemotherapy with autologous transplantation in the treatment of high-risk or relapsed testicular cancer: a systematic review.
Irbaz Bin RiazMuhammad UmarUmar ZahidMuhammad HusnainAhmad IftikharAli McBrideJawad BilalAsad JavedSara AkbarParminder SinghZeeshan AliQurat Ul Ain Riaz SipraFarva Razia GondalFrederick AhmanFaiz AnwarPublished in: Bone marrow transplantation (2018)
Approximately 20-30% of patients with metastatic germ cell cancers (GCCs) can develop relapsed or refractory (RR) disease, about 40-50% of patients who relapse after salvage chemotherapy may reach long-term remission. The goal of this review was to identify patients who appear to benefit from high-dose chemotherapy (HDCT) and autologous stem cell transplant (ASCT). To access this, we performed a systematic medical literature review to evaluate the effectiveness of HDCT in the frontline setting, as well as in patients with RR testicular cancer. We searched databases for interventional clinical studies and identified 5883 studies. We selected 49 studies for inclusion, which included a total of 5985 patients. Seventeen studies reported results of newly diagnosed poor-risk GCC patients and 32 studies reported results of RR patients. For newly diagnosed patients with poor prognostic predictors, a risk adjusted strategy using unfavorable tumor marker decline with initial standard chemotherapy regimen and upfront HDCT demonstrated improved outcomes. Our data suggest a minimum of two HDCT cycles with ASCT should be standard of care for patients with RR GCC. Failure of HDCT results in a poor prognosis with only 10% of patients achieving lasting remission with salvage therapy.
Keyphrases
- newly diagnosed
- end stage renal disease
- high dose
- poor prognosis
- stem cells
- ejection fraction
- randomized controlled trial
- peritoneal dialysis
- acute lymphoblastic leukemia
- palliative care
- bone marrow
- patient reported outcomes
- long non coding rna
- locally advanced
- acute myeloid leukemia
- radiation therapy
- type diabetes
- low dose
- squamous cell carcinoma
- systemic lupus erythematosus
- young adults
- adipose tissue
- metabolic syndrome
- insulin resistance
- multiple myeloma
- platelet rich plasma
- deep learning
- data analysis
- smoking cessation
- chemotherapy induced
- childhood cancer